RC 258
Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
DEXTROSE 5 % IV SOLN
The hospitals that file a Tricare rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.
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108 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | Anderson Hospital Maryville, IL facility · fee schedule · outpatient | 1 | $68.73 | $15.07 – $179.89 |
| 2 | Armstrong County Memorial Hospital Kittanning, PA facility · fee schedule · outpatient | 1 | $242.99 | $10.36 – $421.20 |
| 3 | Ascension Cedar Park Park, TX percent of total billed charges · bothfrom % of charges | 1 | $180.06 | $1.01 – $974.46 |
| 4 | Ascension Cedar Park Park, TX percent of total billed charges · outpatientfrom % of charges | 1 | $180.06 | $1.01 – $974.46 |
| 5 | Ascension St. Vincent Heart Center Carmel, IN percent of total billed charges · outpatientfrom % of charges | 3 | $169.32 | $8.00 – $832.87 |
| 6 | Aspen Valley Hospital District Aspen, CO facility · percent of total billed charges · bothfrom % of charges | 4 | $43.63 | $14.18 – $224.50 |
| 7 | Baptist Medical Center-Attala Kosciusko, MS facility · percent of total billed charges · outpatientfrom % of charges | 1 | $84.54 | $13.77 – $1,546 |
| 8 | Baptist Medical Center-Yazoo Yazoo City, MS facility · percent of total billed charges · outpatientfrom % of charges | 1 | $82.13 | $13.37 – $1,501 |
| 9 | Baptist Memorial Hospital - Leake Carthage, MS facility · percent of total billed charges · outpatientfrom % of charges | 1 | $82.13 | $13.37 – $1,501 |
| 10 | Baptist Memorial Hospital-Calhoun Calhoun City, MS facility · percent of total billed charges · outpatientfrom % of charges | 1 | $103.87 | $16.91 – $1,899 |
| 11 | Beaufort Memorial Hospital Beaufort, SC facility · percent of total billed charges · inpatientfrom % of charges | 1 | $8.09 | $2.11 – $77.69 |
| 12 | CORNING HOSPITAL Corning, NY facility · other · outpatient | 2 | $29.05 | $2.10 – $252.25 |
| 13 | Carmel AmbSurg Carmel, IN percent of total billed charges · outpatientfrom % of charges | 3 | $145.23 | $5.00 – $594.00 |
| 14 | Columbia Lutheran Charities Astoria, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $171.91 | $12.49 – $1,553 |
| 15 | Conway Regional Medical Center Conway, AR facility · fee schedule · outpatient | 1 | $59.93 | $7.42 – $309.02 |
| 16 | Craig Hospital Englewood, CO facility · percent of total billed charges · inpatientfrom % of charges | 1 | $544.83 | $527.13 – $580.06 |
| 17 | Craig Hospital Englewood, CO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $544.83 | $527.13 – $580.06 |
| 18 | Doylestown Hospital Doylestown, PA facility · fee schedule · outpatient | 1 | $38.86 | $15.11 – $92.74 |
| 19 | Dukes Health System LLC Peru, IN facility · fee schedule · outpatient | 1 | $78.23 | $14.33 – $349.72 |
| 20 | Ellis Hospital NY 12308; 2210 Troy Schenectady Road Niskayuna, NY facility · fee schedule · outpatient | 1 | $19.25 | $4.00 – $93.00 |
| 21 | Endo Surgery Center Carmel, IN percent of total billed charges · outpatientfrom % of charges | 3 | $145.23 | $5.00 – $594.00 |
| 22 | Fisher-Titus Medical Center Norwalk, OH facility · percent of total billed charges · inpatientfrom % of charges | 1 | $10.09 | $0.01 – $69.02 |
| 23 | Fisher-Titus Medical Center Norwalk, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $9.46 | $0.01 – $64.71 |
| 24 | GUTHRIE CORTLAND MEDICAL CENTER Cortland, NY facility · other · outpatient | 1 | $40.20 | $2.36 – $336.25 |
| 25 | HOULTON REGIONAL HOSPITAL HOULTON, ME percent of total billed charges · outpatientfrom % of charges | 1 | $21.62 | $21.00 – $33.94 |
← Payers reporting RC 258 · Snapshot 20261108T203506Z-bb90dbab